Breast cancer: Reducing risk – it's not the same as 'prevention'

October 23, 2013
| by Denise Heady

There is no sure way to prevent breast cancer. That's true. But there are some ways women can reduce their risk of the disease. That's also true.

Those risk-reducing measures were discussed during City of Hope's Ask the Experts session earlier this month. The session, titled “The A to Z’s of Breast Cancer Prevention,” featured two of City of Hope’s physician experts on breast cancer as well as an expert with a different perspective – a former patient. (More on this notion of "prevention" later.)

Joanne Mortimer, M.D., director of the Women’s Cancers Program, began the seminar by discussing lifestyle modifications that can decrease the risk of breast cancer. In the video above, Mortimer highlights some common ways to lower that risk, including:

Eating a healthy diet

Maintaining a normal weight

Assessing your personal risk of developing breast cancer

Exercising regularly

“These are all sort of the 'mom-and-apple-pie' recommendations, but they really are important in terms of minimizing your risk in getting breast cancer,” Mortimer said.

She also pointed out a factor that increases the risk of breast cancer: obesity.

“We are in the midst of this obesity epidemic, and it turns out that obesity is associated with an increased risk of developing breast cancer,” Mortimer said. “It also turns out that women who are overweight and obese, and who are treated for breast cancer, actually don’t do as well as women who are of normal weight.”

Women who drink alcohol on a regular basis face an increased risk as well.

“There’s a balance here,” Mortimer said. “We all know alcohol is sort of good for protecting your heart from heart disease, but there’s a certain amount that’s protective and a certain amount that if you exceed may increase your risk for getting breast cancer.”

The pros/cons of genetic testing

During her part of the presentation, Laura Kruper, M.D., director of City of Hope’s Rita Cooper Finkel and J. William Finkel Women’s Health Center, focused on genetic mutations and who should undergo genetic testing.

The four main genetic mutations are BRCA1, BRCA2, P-TEN and Li Fragumeni. Carrying one of these gene mutations does not guarantee a breast cancer diagnosis, but it does increase the risk of occurrence.

Only about 5 to 10 percent of breast cancers result from inherited mutations, and genetic testing is required for a definitive answer on whether a person carries one of those mutations — particularly BRCA1 or BCRA2. Because less than 1 percent of women actually have a BRCA mutation, genetic testing is unnecessary for most people.

Once a woman is aware she carries a genetic mutation, she then faces a difficult choice, Kruper explained – whether or not to have a prophylactic mastectomy. "We know now that having both breasts removed in a woman who is at high risk of developing breast cancer will reduce both the incidence and death from breast cancer,” Kruper said.

But the decision is not a clear one. Surgery carries risks, too.

“The most important thing for a woman who is considering this [prophylactic mastectomy] or has a strong family history, is to know that this is not something to be taken lightly. We really have to talk to this woman in depth and the woman has to be evaluated by a multidisciplinary team.”

Women who undergo a mastectomy now have more options to help make their breast appearance as normal as possible — including nipple-sparing mastectomy, which removes all the breast tissue without removing the nipple.

“For a lot of women who are faced with a big decision such as risk reduction, it’s something nice we can offer our patients so they feel like they maybe retained some of their normal appearance," Kruper said.

We must point out that "prevention" is, of course, not accurate, even if attention-getting. Breast cancer, or any cancer, can't actually be prevented. Sometimes, no matter how much a woman tries to reduce the risk, it happens.

Blogger and cancer survivor Liza Bernstein eloquently, and quite forcefully, writes in "Seeing RED (I mean, PINK)," that the very word "prevention" is misleading. Arguing for a more accurate choice of words, she proposes an alternative:

"Things to do to (hopefully) reduce your risk of getting breast cancer due to some (but definitely not all) of its known associated risk factors that might be susceptible to as of yet un-knowable levels of reduction if you do actually do the things we're telling you to do but which might not be. Or something like that. Results Not Guaranteed. No Refunds."

We'd go for that.

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Make sure to catch City of Hope’s next free health seminar “Progress in Personalized Treatment for Lung Cancer” on Nov. 20 to learn more about lung cancer screenings, surgical options, target therapies, personalized medicine and much more. Admission is free and you can reserve your seat now by visiting cityofhope.org/AskTheExperts or calling 800-535-1390, ext. 65669.